2015 > August

Working parents often feel like they are trying to juggle five plates, but can only keep four plates up in the air, so one is always crashing down. Many parents have found that the one falling is not always the same one, and they find themselves experiencing success in four areas of their lives, while one breaks on the floor.

So how do you fix the problem? Can you keep all the plates spinning at once? Or do you choose one plate to focus on at one time or another? Parents try to put the kids first most of the time, but it may not always work. One mother, Rena Seltzer, ACSW, has listened to advice she received from her mentor. “I think about the kids being in childcare as sharing my children with the universe,” she said. When she sees the loving relationship between her two year old and his daycare provider, Seltzer feels good that she can share the joy of her two-year-old with another warm and caring person.

It is important to note that there is no one way, no correct way, to achieve an artful balance in your life. You should figure out what works best for you and your family and use that method to your benefit. What are some of the strategies you might be able to adapt and work in to your life?

1. Build a Support Network

Ask for help and allow yourself to be helped and contributed to. Get your children involved–work together as a team. Between work and family, surprises are inevitable. Be prepared by creating back-up and emergency plans and always have a contingency.

2. Let Go of Guilt

Guilt can cause you to become immobilized in the present because you are dwelling on the past. Guilt can be very debilitating. By introducing logic to help counter-balance the guilt, you can avoid sabotaging your efforts toward balance and stay better on course.

3. Establish Limits and Boundaries

Boundaries are an imaginary line of protection that you draw around yourself. They are about protecting you from other people’s actions. Determine for yourself what is acceptable and unacceptable behavior from other people. Boundaries and limits define how you take charge of your time and space and get in touch with your feelings.

4. Determine Your Own Standards

Get rid of the notion of being a perfectionist. Make compromises. Figure out where the best places to make the compromises are without short-changing yourself, your spouse, your children, your boss, etc. Live by your own standards rather than someone else’s.

5. Be Flexible

Forgive yourself when things don’t get done. Understand that with children things change at a moment’s notice. Be ready and willing to assume responsibility for any of the tasks that need to get done at any time. Never get too comfortable, because as soon as you seem to get things under control, they change!

Natalie A. Gahrmann, a life coach, recommends that families begin this process by spending quality, focused time with your family. “Give them your full attention and develop rituals you can all look forward to,” she said. “Create relationships with your spouse and children that are not incidental, but rather, instrumental to your family’s success.”

One physician, who worked in public health, was attempting to reach an ideal work-life balance and faced a challenge one day when she was investigating an outbreak of food poisoning. The physician purchased some fast food, as a test, to search for the source of the outbreak. Then, she got a call from her kids’ school. The school was closing early; she needed to go pick up her children. The physician stopped to do an errand on the way home, leaving the kids in the car for a few minutes, and when she returned to the car, her kids had been chowing down on the test food. Since her kids did not get sick, she was able to rule it out as the source of the outbreak.

Overall, finding your ideal work-life balance is a continuous process. There will be some days when you test the food and forget to pick up the kids, and there will be other days when you stay home with your kids and put off testing the food.

Living a balanced life is about integrating those components of your life that are truly important to you and realizing that sometimes you need to make choices about what has to come first. Making choices is powerful and allows you to live a balanced life that makes you and your family feel happy and content.

There are many reasons why people start running: Busting stress, boosting energy, or snagging that treadmill next to a longtime gym crush are just a few. What’s more, running can keep your heart healthy, improve your mood, stave off sickness, and aid in weight loss. But depending on your personal goals, going full speed isn’t the only route to good health.

While walking can provide many of the same health benefits associated with running, a growing body of research suggests running may be best for weight loss. Perhaps unsurprisingly, people expend 2.5 times more energy running than walking, whether that’s on the track or treadmill. For a 160-pound person, running 8 mph would burn over 800 calories per hour compared to about 300 calories walking at 3.5 mph.

And when equal amounts of energy were expended, one study found runners still lost more weight. In this study, not only did the runners begin with lower weights than the walkers—they also had a better chance of maintaining their BMI and waist circumference.

Running may also regulate appetite hormones better than walking. In another study, after running or walking, participants were invited to a buffet, where walkers consumed about 50 calories more than they had burned and runners ate almost 200 calories fewer than they’d burned. Researchers think this may have to do with runners’ increased levels of the hormone peptide YY, which may suppress appetite.

However, aside from weight loss, walking has definite pros. Researchers looked at data from the National Runners’ Health Study and the National Walkers’ Health Study and found that people who expended the same amount of calories saw many of the same health benefits. Regardless of whether they were walking or running, individuals saw a reduced risk of hypertension, high cholesterol, diabetes, and improved better cardiovascular health. And running does have downsides: It puts more stress on the body and increases the risk for injuries like runner’s knee, hamstring strains, and shin splits.

When running isn’t in the cards, walking with added weight might be the next best bet for an effective workout. Research shows that walking on the treadmill while wearing a weighted vest can increase the metabolic costs and relative exercise intensity. Similarly, increasing the incline on the treadmill makes for a more effective walking workout. A study showed that walking at a slow speed (1.7 mph) on a treadmill at a six-degree incline can be an effective weight management strategy for obese individuals, and help reduce risk of injury to lower extremity joints. Picking up the pace slightly almost always helps. One study found speed walkers had a decreased risk of mortality over their slower counterparts.

Regular cardio (at any speed) is part of a healthy lifestyle. But, lap for lap, running burns about 2.5 times more calories than walking. Running may also help control appetite, so runners may lose more weight than walkers no matter how far the walkers go. Overall, the best possible workout for anyone would be a nice run, whether outside during nice weather, or inside at the gym while watching a favored television show.

This keyboard is something that can finally compare with a Microsoft Surface product. The keyboard is clicky and sized well, feeling much more like a solid laptop then a junky tablet accessory. It’s expensive, at $189, but if investing some money in turning your iPad into more of a work machine, it’s worth the cost.

9. Surface 3

Microsoft finally released a cheaper Surface product that doesn’t feel like a waste of your time. The original Surface and Surface 2 suffered from a processor that kept it from being anything more than a confusing mess of operating systems and features. The Surface 3, however, was finally given the processing power to make it a true tablet/laptop hybrid. At $499, it’s a pretty fair competitor with the iPad Air 2—and is even good enough to win over some who are looking at buying a Windows laptop. The best part is that with Windows 10 coming, the Surface 3 will finally get software worthy of the great hardware.

8. LG G4

The G4 doesn’t have the same jaw-dropping design that the G3 had, but the G4 still has the goods where it really counts. More specifically, it’s got one of the best smartphone cameras on the market and one of the highest resolution displays you’ll ever see. Furthermore, it’s really the only flagship smartphone worth buying that still has expandable storage and a removable battery.

7. Dell Venue 8 7000

Though it’s admittedly a little odd-looking, the tablet is one you’ll quickly get used to. Once you realize even the chunky bottom piece is being used, thanks to the front-facing speaker grill, it’s easily the best Android tablet of the year.

6. Pebble Time

The Apple Watch isn’t the only smartwatch in town. Pebble was one of the very first on the market and its latest device, the Pebble Time smartwatch smashed Kickstarter records for its crowdfunding campaign in March, reaching millions in days. The battery life and lower price are two things that truly set it apart from the host of other smartwatches out there and make it far more than just an Apple Watch alternative.

5. Dell XPS 13

Dell has created one of the most beautiful laptops ever. Other than that, the XPS 13 is a fairly standard, though high-powered ultrabook—though you should probably go for the $1,299 Touch version to get the QuadHD 3200 × 1800 display.

4. Amazon Echo

The Echo is essentially Siri for your home—you can ask it pretty much any question and can perform a variety of Siri-like functions with just its microphone and speaker. In many ways, it’s still very much an experiment (and it’s honestly a little weird how disconnected it is from your smartphone), but the technology really is there to make for a truly exciting piece of home technology.

3. MacBook

It’s a laptop so thin that it’s almost hard to believe they squeezed everything into such a tight package. The truly spectacular thing about the MacBook’s size, though, is how it forced the people at Apple to re-engineer and re-design so many aspects of a functioning laptop. It might be a bit expensive for what you’re getting spec-wise right now, but there’s no question that the MacBook is the future of laptops.

2. Galaxy S6 Edge

The Galaxy S6 Edge has one of the most interesting smartphone designs you’ll ever see. Unlike so many of Samsung’s failed design experiments, the curved display on the S6 Edge actually enhanced the experience of using it. Because it wraps around the edges of the front of the device, the S6 Edge really feels unique in one’s hands.

1. Apple Watch

No other device is going to gather a crowd of people around when worn in public—and it’s not just due to the hype. The design of the Apple Watch is fantastic and immediately iconic, not unlike what Apple has done time and time again with its new product launches. The Apple Watch has a long way to go in terms of realizing the dream of a smartwatch that actually earns its spot on your wrist, but it will in a few years.

Between 2008 and 2020 the number of Americans older than 65 years will have increased by 36%, while the physician supply will hardly keep up with a corresponding 7% increase, according to a report published in 2010 by the Association of American Medical Colleges (AAMC) Center for Workforce Studies.

Using the latest modeling methods and available data, AAMC projected a shortfall of between 46,100 and 90,400 physicians by 2025, most in primary care. All Americans are likely to be affected, but the shortfall may have the greatest effect on the approximately 20% of our population that lives in rural and underserved areas. As a medical community, how do we address this evolving health disparity?

One solution that has begun to be met with great success is telehealth. According to the American Telemedicine Association (ATA), “Formally defined, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.” A 2012 systematic review of the telemedicine program at the University of Pittsburgh Medical Center (UPMC) found that sites using telemedicine resources had lower medical and pharmacy costs, delivered services more efficiently, and had lower rates of hospital admission and readmission.

Telemedicine also may help reduce costs associated with unneccesary hospitalizations of nursing home residents. In a controlled study, use of telemedicine instead of an on-call system for physician coverage in nursing homes was found to generate cost savings for Medicare that exceeded a facility’s investment in the telemedicine service.

In addition, telemedicine has been shown to improve self-management of diabetes by facilitating management of symptoms, diet, body mass index, and blood pressure and glucose levels. It also has been used as an effective mental-health tool: Psychiatric interviews conducted over videoconferencing have been found reliable for making a diagnosis and offering treatment recommendations.

With respect to management of chronic diseases such as congestive heart failure, stroke, and chronic obstructive pulmonary disease, telemedicine has proven to increase the quality of long-term monitoring and decrease or prevent complications. There have been many advantages of telemedicine that medical practitioners have been able to quantify.

But is telemedicine really ready for prime time? UnitedHealthcare, the country’s largest insurer, seems to think that it is just as valuable as a traditional doctor’s visit. UnitedHealthcare recently expanded coverage options for virtual physician visits, giving patients enrolled in self-funded employer health plans secure, online access to a physician via mobile phone, tablet, or computer 24 hours a day. Other insurers such as BlueCross BlueShield, Wellpoint, and Oscar also have adopted telemedicine coverage.

However, coverage and reimbursement rates for telemedicine significantly vary by state. Twenty-four states mandate some type coverage for telemedicine by private insurers. Forty-eight states have some degree of coverage in their Medicaid programs. On the flip side, some states—such as Texas, with support from the Texas Medical Association—still do not support coverage of telemedicine programs.

In addition, there are many legal hoops physicians and patients must jump through. With telemedicine, the physician and patient may be physically located in different states. When this happens, in which state or states is medicine being practiced? Practicing medicine always requires licensure by the state in which the provider is working, but a valid license in the state where the patient is located also may be required.

Although telemedicine cannot replace the sensitivity and specificity of a doctor’s touch, it is reassuring to know that there is scientific evidence to demonstrate that the technology is a viable solution for our widening physician deficit. How will telemedicine will change our practices? Will physicians become stay-at-home “telemedicine-based” practitioners? Is it possible to have an entire medical career that is solely online? Only time will be able to provide effective answers to these questions.

As the healthcare industry has evolved, so too have the methods physicians use to attract patients and impact their community. A half-century ago, hanging a shingle and having a solid work ethic was the secret to success. But today, physicians need to know how to position themselves in a population health management marketplace where strategic affiliations, the ability to differentiate and a value-driven (rather than volume-driven) philosophy create customers for life.

While there are many tools in a marketing toolbox, none is better suited for today’s physicians than public relations. That’s because public relations combine high credibility and a relatively low cost. Resources put into public relations are dollars well spent as public relations can help build your brand, raise your visibility, and position you and your practice in a favorable light.

Public relations programs involve strategy and tactics, science and art, and fundamentals and creativity. And just as physicians hone their craft through merging indispensable education with practical experience, so too the best public relations professionals find a way to successfully transition textbook theory into real-world know how. So, how can you leverage public relations for your practice? Here are five important strategies:

1. Tap into local media. Send out press releases on a variety of things, including: new physicians joining your practice, local community involvement, new services offered, or milestones reached. In addition, you could be writing a weekly or monthly health-tips column for your community newspaper and then “repurposing” these columns by posting them to your website or having reprints available in your lobby.

2. Reach out to the community. Find opportunities to speak on your area of expertise at appropriate community or business gatherings. Look for chances to speak at the worksites of local employers or employer-sponsored events and be proactive by inviting the media. That way, you and your message have the potential to reach more people than actually attend your presentation.

3. Be opportunistic. Look for opportunities to cleverly piggyback your messaging and activities with appropriate health observances, such as American Heart Month, or weeks that call attention to diabetes, cancer, Alzheimer’s, etc. The Society for Healthcare Strategy and Market Development publishes an annual guide listing all of these observances.

4. Be current and relevant. Develop an online marketing strategy that allows you to push messages directly to your patients or other members of the community in a timely and effective manner. Keep your website current and invite two-way communication through social media and allowing your patients (and others) to communicate with you through whichever medium they feel most comfortable. Today it’s all about “the patient experience” and that involves your interactions before, during and after their office visit.

5. Leverage hospital relationships. Let your affiliated hospital know that you are available as a source when the media calls, when they require a physician to quote in their employee or community newsletter, or when they need a physician to represent them at a community function.

It’s easy and simple to hire a public relations manager these days if you do not have time to commit to overseeing it yourself. It is an indispensable part of any business plan, and the physician who is able to leverage public relations is the one with the best practice.

Health officials in the Philippines reported earlier this month that the country’s second case of Middle East Respiratory Syndrome was diagnosed in a 36-year-old foreign man who had flown in from Dubai. The country has stepped up surveillance and quarantine measures at ports of entry and in the city of Muntinlupa, south of Manila, the country’s capital. Patients at the hospital where the man is being treated were donning face masks and taking precautions to prevent against the spread of the disease.

The man reportedly had a low amount of virus in his body and officials quickly located and began monitoring eight people he had come into contact with. The Philippine government has declined to release any additional information about the man, including his nationality, occupation or the reason for his trip to the Philippines.

The World Health Organization has not recommended any type of travel or trade restrictions related to MERS but has asked anyone entering the country to report to a hospital if they experience signs of a flu such as a fever with cough that are very similar to symptoms of MERS.

The first case of MERS was in February when a nurse who came from Saudi Arabia tested positive for the disease. She recovered and was declared free of the virus within a few weeks. South Korea is still grappling with an outbreak of MERS within its borders, and as of Monday 185 cases have been confirmed. Thirty-three of those patients have died, according to the WHO.

The national authorities of Saudi Arabia and the United Arab Emirates have been informed. Investigations on the possible exposure and contact tracing are ongoing, and enhanced disease surveillance is being implemented. Globally, since September 2012, WHO has been notified of 1,368 laboratory-confirmed cases of infection with MERS, including at least 487 related deaths.

It is not always possible to identify patients with MERS early because like other respiratory infections, the early symptoms of MERS are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis. Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS infection; and airborne precautions should be applied when performing aerosol generating procedures.

South Korea has recorded about 200 cases of MERS over the past six weeks, including more than 30 deaths. The South Korean outbreak began on May 20 when a 68-year-old man was diagnosed after returning from a trip to Saudi Arabia. Since then the virus has spread at a rapid pace, sparking public alarm that prompted the temporary closure of thousands of schools and trip cancellations by more than 120,000 foreign tourists.

Almost all patients were infected in hospitals and the World Health Organization (WHO) said it had found no evidence of transmission of the virus within communities outside hospitals.

John LaRosa, research director at Marketdata Enterprises, has studied the weight loss industry for over 20 years and estimates that medical weight loss programs, which include those run by hospitals and clinics, bring in $1 billion annually and that the market will grow about 5 percent a year through 2019. The prospects are so lucrative that in March 2015, LaRosa sponsored a seminar advising entrepreneurs how to open their own weight loss clinics.

Most insurance providers reimburse patients for at least a small portion of the bill, thanks to a provision in the federal health care law that requires insurers to pay for nutrition and obesity screening, which has created a financial opportunity for these clinics. But the prospect of rapid growth in the diet clinic industry, fed by those insurance payments, has exposed deep philosophical differences on the best ways to help patients lose weight.

Obesity specialists at major medical centers say the proprietors of diet clinics often employ unproven tactics — including vitamin injections, costly supplements, and extreme diet plans — that lure customers but do not lead to lasting results. Diet clinic owners contend they are filling a needed role because the mainstream medical establishment pays little attention to patients’ struggles with weight.

Sustained weight loss is notoriously difficult to achieve. Lasting results require long-term care and follow-up, said Michael D. Jensen, the director of the obesity treatment research program at Mayo Clinic in Rochester, Minn., who has studied the effectiveness of weight loss programs.

Few clinics follow patients long enough to demonstrate their programs’ effectiveness, although they point to individual success stories and say they do offer comprehensive behavioral counseling. Some are trying to improve treatment standards by employing doctors with backgrounds in obesity and certified nutritionists, while recommending only evidence-based treatments. And they say they offer real options to patients who have been shunned by mainstream medical providers.

But Dr. John Morton, chief of bariatric surgery at Stanford University School of Medicine, said diet clinics should not be the focus of expanded obesity coverage. “Those clinics exist all over the country, and my point about it is we need something better than that,” he said. Even with attentive doctors at the helm, these clinics often employ techniques that are unproven and even some that have been discredited.

Others say tactics like extreme diets and unproven supplements are misleading at best and fraudulent at worst. Michael D. Jensen, Mayo Clinic obesity researcher, studied the effectiveness of weight-loss programs and found that patients who used short-term treatments were not able to keep the weight off.

Many clinics make a profit from selling products to patients, as well as prescription weight-loss drugs like phentermine, which is widely prescribed in diet clinics. And selling medication at a for-profit clinic, whether as part of a package or on its own, still raises red flags for obesity specialists like Jensen. “Clearly, if they’re making money off of it, that’s a conflict of interest,” he said.

Overall, these clinics are becoming more and more popular throughout the United States, but as medical practitioners, we should be wondering how we can step up to help our own patients first before they feel the need to resort to these for-profit clinics.

Concierge medicine allows doctors to charge a flat monthly fee for services. It’s an idea that finally might be catching on throughout the country. Long thought of as a perk for the rich, concierge medicine has in recent years become more appealing for patients across income brackets. More important, perhaps, is that concierge medicine is becoming more attractive to physicians.

What Exactly Is Concierge Medicine?

Concierge medicine is a private form of practice where doctors charge patients an out-of-pocket retainer fee for full access to their services. Patient loads typically decrease when a physician switches from more traditional fee-per-service practice to concierge medicine. While there are a small number of physicians practicing concierge medicine today — about 5,000 according to the American Academy of Private Physicians — that number has grown in recent years.

More than 20 percent of physicians today say they’re either currently practicing concierge medicine or plan to do so in the future. Often, younger physicians are those who seem more inclined to make the transition.

Fewer Patients Is a Plus

One of the main upsides to concierge practice is the decrease in patients, coupled with an increase in pay. A concierge doctor may have 500 patients, while a doctor in a traditional practice may have 2,000. The doctor with the 500 patients is on retainer and has predictable revenue. The physician also spends more time with the patient and gets to know them. The doctor with thousands of patients may be hard-pressed to form that same type of relationship and is paid only when a patient comes in.

Average retainers vary from practice to practice, but at one of the largest concierge networks, membership fees range from about $1,650 to $1,800 a year. Insurance through the Affordable Care Act (ACA) costs an average of $307 a month (or about $3,600 a year) for a 50-year-old nonsmoker, according to data analyzed by Avalere Health.

Concierge Appeal Is Spreading

Florida-based MDVIP was founded in 2000 and has grown to a national network of more than 800 physicians. It’s a network where the doctors do everything—from teaching healthy eating courses to grocery shopping with patients. Doctors also go on walks with their patients and work with them extensively on things like hypertension and diabetes wellness plans.

Physicians in traditional practices can have between 2,500 and 4,000 patients. MDVIP physicians are capped at 600. An annual membership in MDVIP ranges from $137 to $150 a month. The MDVIP model offers some of concierge medicine’s positives. The minimum appointment time is 30 minutes, compared to the average seven to eight minutes at a traditional practice. It also guarantees same or next-day appointments.

MDVIP sees results. They have a 90 percent renewal rate and a 90 percent reduction in hospital readmission. Patients at MDVIP often benefit from the access to the doctors, including the fact they can text and email their physicians.

Getting Away from “Sick Care”

One of the reasons concierge patients like the system is because it’s not “sick care.” A concierge doctor typically has more time to work on preventative care than a traditional physician. Networks like MDVIP and others have made a point to reemphasize preventative care and frame it in a positive light for their patients.

Overall, concierge medicine is forcing physicians to adapt the different ways they see and treat patients. It means a decrease in the number of patients one sees, and deepens the doctor-patient relationship.

Recently, the state of California passed a law that requires almost all California school children to be fully vaccinated in order to attend public or private school, regardless of their parents’ personal or religious beliefs. California now joins only two other states — Mississippi and West Virginia — that permit only medical exemptions as legitimate reasons to sidestep vaccinations.

Many people who opposed the law began to debate “personal liberties,” and “personal freedoms,” as anti-vaccination groups began to scheme about how to take down the law. Debates over public health and personal liberty can seem utterly of the moment in response to new and evolving threats, but a flashback to our nascent nation in the summer of 1776 — when liberty was pretty much the topic of the day — can reveal just how long the debate over government health policies has been running, and how the meaning of “freedom” has changed when it comes to access to preventive medicine.

In Boston, the first Independence Day was preceded by inoculation day, when the Massachusetts general court abolished a ban on inoculating people against small pox. Only people who wanted to be inoculated or had already had the disease were allowed in the city. To leave the city before the inoculation period had ended, people needed the permission of a doctor or judge.

Two years earlier, 20 men in Marblehead brought torches and tar to burn down a new hospital — not because of corporate fascists who were forcing them to get vaccines, but to protest the high-cost system that was shutting the poor out from access to small pox inoculations. Hannah Winthrop, the wife of Harvard mathematics professor John Winthrop, described the scene: “Boston has given up its Fears of an invasion & is busily employd in Communicating the Infection. … Men Women & children eagerly crowding to inoculate is I think as modish as running away from the Troops of a barbarous George was the last year.”

But strict laws such as California’s can seem to some like an authoritarian scheme that threatens carefully guarded personal liberties. Even public health experts who unequivocally think that vaccination needs to be more widespread are unsure whether despite good intentions, the new law could backfire and have the unintended consequence of strengthening the anti-vaccination movement. If anything, history teaches us that debates over public health and liberty predate government as we know it and are likely to rage on — although no one expects any hospitals to be burnt down in 2015.

Instead of mandatory vaccinations, U.S. medicine has largely been guided by an idea traced to an influential medical textbook called Domestic Medicine, in which public health policies help reinforce “custom, which was the strongest of all laws. If you didn’t vaccinate, there would be enough pressure on you. Ostracism from the community would be enough.”

At the least, the situation in California might be seen as an experiment — when custom breaks down and outbreaks occur, what is the best solution? Will a strict new law mean more children will be vaccinated and measles declines, or will the anti-vaccine movement gain strength?